Workers’ Compensation · Primary-source case analysis

Illinois Midwest: Ongoing Home Health Care Still Required UR and IMR Review

By Aneeta Mishra and Timothy Chan

Published April 22, 2026

Illinois Midwest rejects an extra-statutory WCAB route for deciding medical necessity merely because a worker previously received the same treatment over an extended period.

Home health services were repeatedly authorized

After a severe industrial brain injury, Orlando Rodriguez received home health care through a series of time-limited requests. The carrier later disputed renewed authorization.

Each disputed request followed the statutory path

The Legislature assigned treatment-necessity decisions to utilization review and, if challenged, independent medical review. Prior approvals did not give the WCAB original authority to decide whether a new period of care remained medically necessary.

No continuing-treatment exception survived the reforms

The court rejected Patterson to the extent it allowed an extra-statutory proceeding for ongoing treatment under the post-2013 system. Different rules may apply to older injuries or procedural defects expressly reviewable by the Board.

Disposition

The court annulled the WCAB decision and remanded. It did not decide whether home health care was medically necessary; that medical question belonged in UR and IMR.

Key takeaways

• Submit timely authorization requests for each treatment period.
• Challenge medical-necessity denials through IMR.
• Do not equate prior approval with permanent authorization.
• Separate procedural defects from the merits of medical necessity.